The weight-adjusted-waist index predicts all-cause and cardiovascular mortality in general US adults

Han, Ying; Shi, Jieli; Gao, Pengfei; Zhang, Lin; Niu, Xuejiao; Fu, Na

doi:10.1016/j.clinsp.2023.100248

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Sumário

Original articles • Clinics 78 • 2023 • https://doi.org/10.1016/j.clinsp.2023.100248 copy

The weight-adjusted-waist index predicts all-cause and cardiovascular mortality in general US adults

Authorship SCIMAGO INSTITUTIONS RANKINGS

Highlights

WWI was a potential predictor for cardiovascular mortality with a cut-off of 11.33.
Higher WWI associated with an increased 95% risk for cardiovascular mortality.
Higher WWI associated with an increased 68% risk for all-cause mortality.

Abstract

Background

The authors examined the relationship between Weight-adjusted Waist Index (WWI) and all-cause and cardiovascular mortality among adults in the US.

Methods

This prospective cohort study included 26,882 individuals who participated in the National Health and Nutrition Examination Survey (NHANES) from 2005 through 2014. WWI was calculated as waist circumference divided by the square root of weight. The main outcomes of this study were all-cause mortality and cardiovascular mortality. Mortality status and cause of death were determined by NHANES-linked National Death Index records through December 31, 2015. Cox proportional hazard models and Kaplan-Meier analysis were used to estimate Hazard Ratios (HR) and 95% CIs for mortality for all causes and cardiovascular diseases.

Results

A total of 26,882 participants with a mean WWI of 10.89 ± 0.01, of whom 49.23% were male. The average follow-up time was 68.95 ± 1.07 months, and 1870 participants were determined as deceased (4.99%), including 349 cardiovascular death (0.88%). The Kaplan-Meier analysis demonstrated a significant difference in all-cause and cardiovascular mortality between patients with WWI <11.33 and ≥11.33 (both log-rank testp < 0.0001). The fully adjusted Cox proportional hazard model indicated that a higher WWI level (≥ 11.33) was associated with an increased 95% risk for cardiovascular mortality (HR = 1.95, 95% CI 1.30‒2.93) and 68% risk for all-cause death (HR = 1.68, 95% CI 1.41‒2.00) compared with the counterparts.

Conclusions

Elevated WWI levels were associated with a higher risk of cardiovascular mortality and all-cause mortality independently.

Keywords
Weight-adjusted-waist index; All-cause death; Cardiovascular death; Mortality; NHANES

	Overall	Still alive, N= 25,012	Deceased, N= 1870	P value
Age (years),% (SE)
18-39	38.80 (0.70)	40.42 (0.72)	7.98 (0.88)	<0.0001
40-59	37.73 (0.48)	38.53 (0.50)	22.47 (1.38)
≥ 60	23.48 (0.54)	21.06 (0.52)	69.55 (1.42)
Gender,% (SE)
Male	49.23 (0.31)	48.97 (0.32)	54.18 (1.38)	0.0003
Female	50.77 (0.31)	51.03 (0.32)	45.82 (1.38)
Race,% (SE)
Mexican American	8.50 (0.76)	8.61 (0.77)	6.46 (0.86)	<0.0001
Other Hispanic	5.21 (0.52)	5.33 (0.54)	2.78 (0.60)
Non-Hispanic White	68.20 (1.51)	67.82 (1.52)	75.45 (1.05)
Non-Hispanic Black	11.30 (0.80)	11.31 (0.80)	11.04 (1.05)
Other Races	6.79 (0.40)	6.93 (0.41)	4.27 (0.75)
Education level,% (SE)
Less than high school	18.02 (0.66)	17.26 (0.65)	32.53 (1.59)	<0.0001
High school or GED	23.39 (0.53)	23.19 (0.54)	27.25 (1.27)
Above high school	58.52 (0.96)	59.49 (0.96)	40.11 (1.86)
Others	0.06 (0.02)	0.06 (0.02)	0.11 (0.07)
Smoking status,% (SE)
Never	52.87 (0.63)	53.61 (0.64)	38.76 (1.46)	<0.0001
Ever	23.47 (0.48)	22.71 (0.50)	38.04 (1.57)
Current	20.92 (0.51)	20.82 (0.52)	22.72 (1.22)
Unknown	2.74 (0.14)	2.86 (0.15)	0.48 (0.21)
Diabetes,% (SE)	8.32 (0.23)	7.64 (0.22)	21.36 (1.20)	<0.0001
Hypertension,% (SE)	30.21 (0.52)	28.83 (0.53)	56.58 (1.51)	<0.0001
BMI (Kg/m2)	28.56 ± 0.08	28.57 ± 0.08	28.33 ± 0.16	0.1995
SBP (mmHg)	122.07 ± 0.22	121.44 ± 0.21	134.18 ± 0.69	<0.0001
DBP (mmHg)	70.55 ± 0.19	70.74 ± 0.19	66.80 ± 0.49	<0.0001
Urinary albumin (mg/L)	31.15 ± 1.52	25.93 ± 1.12	132.10 ± 20.50	<0.0001
Urinary creatinine (mg/dL)	121.87 ± 0.93	122.66 ± 0.95	106.68 ± 2.09	<0.0001
ALT (U/L)	25.65 ± 0.16	25.67 ± 0.15	25.36 ± 1.08	0.7753
AST (U/L)	25.79 ± 0.13	25.65 ± 0.11	28.54 ± 0.90	0.0014
Serum creatinine (mg/dL)	79.07 ± 0.26	78.07 ± 0.24	98.40 ± 2.01	<0.0001
Serum uric acid (μmol/L)	322.96 ± 0.88	321.65 ± 0.86	348.32 ± 3.27	<0.0001
Total cholesterol (mmol/L)	5.03 ± 0.01	5.04 ± 0.01	4.92 ± 0.04	0.0031
Triglycerides (mmol/L)	1.73 ± 0.02	1.73 ± 0.02	1.78 ± 0.04	0.2229
Fasting plasma glucose (uIU/mL)	5.83 ± 0.02	5.79 ± 0.02	6.61 ± 0.11	<0.0001
HDL-C (mmol/L)	1.37 ± 0.00	1.37 ± 0.01	1.37 ± 0.01	0.7395
LDL-C (mmol/L)	2.95 ± 0.01	2.96 ± 0.01	2.78 ± 0.04	<0.0001
WWI	10.89 ± 0.01	10.86 ± 0.01	11.46 ± 0.03	<0.0001
Follow-up time (month)	68.95 ± 1.07	69.97 ± 1.11	49.45 ± 0.90	<0.0001

	Total	WWI<11.33	WWI ≥11.33
No. (Unweighted)	26,882	17,731	9151
All-cause Mortality,% (SE)	4.99 (0.21)	3.07 (0.17)	9.54 (0.44)
Cardiovascular Mortality,% (SE)	0.88 (0.06)	0.49 (0.05)	1.81 (0.14)
Follow-up time, month (Mean ± SE)	68.95 ± 1.07	70.79 ± 1.13	64.60 ± 1.15
Cause of death
Diseases of heart,% (SE)	15.94 (0.94)	14.56 (1.23)	16.99 (1.29)
Malignant neoplasms,% (SE)	23.26 (1.36)	23.97 (2.01)	22.72 (1.80)
Chronic lower respiratory diseases,% (SE)	1.93 (0.35)	1.65 (0.69)	2.14 (0.52)
Accidents (unintentional injuries),% (SE)	1.69 (0.37)	3.20 (0.66)	0.53 (0.36)
Cerebrovascular diseases,% (SE)	1.78 (0.49)	1.56 (0.69)	1.95 (0.55)
Alzheimer's disease,% (SE)	1.17 (0.21)	1.41 (0.49)	0.99 (0.38)
Diabetes,% (SE)	0.95 (0.31)	0.59 (0.35)	1.22 (0.47)
Influenza and pneumonia,% (SE)	0.23 (0.13)	0.37 (0.26)	0.13 (0.13)
Nephritis, nephrotic syndrome and nephrosis,% (SE)	0.64 (0.13)	0.55 (0.26)	0.71 (0.29)
Others,% (SE)	52.41 (1.69)	52.13 (2.37)	52.61 (2.03)

	HR (95% CI) WWI ≥ 11.33 versus <11.33
Cardiovascular Mortality
Death, No./total No.	349/26,882
Crude model (Model 1)	3.73 (2.99, 4.64)
Minimally adjusted model (Model 2)	1.78 (1.41, 2.23)
Fully adjusted model (Model 3)	1.95 (1.30, 2.93)
All-cause Mortality
Death, No./total No.	1870/26,882
Crude model (Model 1)	3.03 (2.76, 3.32)
Minimally adjusted model (Model 2)	1.56 (1.41, 1.72)
Fully adjusted model (Model 3)	1.68 (1.41, 2.00)

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[1] * Corresponding author. E-mail address;jielishi123@126.com (J. Shi).